I’m ok with being weird but I’m not sure I can pick a flavour

My name is Ant Smoothey and my brain is different. I’ve always known I’m different, it’s very obvious to me. People worry about things that seem completely trivial to me, I worry about things that seem completely trivial to others. I was born this way.

The revelation for me was discovering that there are others whose brains are the same. Whilst researching reasons that people procrastinate, one of the reasons that cropped up was ADHD. My image of people with ADHD was the classic (but quite incorrect) space cadet or dreamer. The moment of revelation came when I learned about something called Hyper-focus, which can form part of ADHD. People who know me regularly get to see me tackle a task so single-mindedly and do something which others might have deemed impossible to achieve in a short timescale.

Give me something mundane and I’m fighting myself every step of the way to get it done (that reminds me, I probably should do my expenses at some point!)

There is also something that can look very similar to Hyper-focus (but has a much less sexy name!) called Monotropism. This is where a person has a restricted set of interests which they devote a disproportionate amount of time to. This resonates with me also, as a child my first nickname was “The Lego King”, until age six when I discovered computers…

Monotropism is associated with Autism, also known as Autism Spectrum Disorder (ASD) or until relatively recently in its milder forms, Asperger’s Syndrome. There is a good chance, as part of my formal ADHD diagnosis, that I will also be diagnosed as Autistic.

There is a collective term for both conditions: Neurodiversity. There is a school of thought that there are many interrelated conditions that comprise Neurodiversity and it’s not uncommon to see a diagram a bit like this (I’ve put my own spin on it!):

Fig 7 – The Neurodiversity butterfly (with apologies to Mary Colley)

The Bad Stuff

I’m not going to sugar coat it, for some people it can be really bad. Compared to some people I have met I consider myself extremely lucky. Trigger Warning! I can’t watch this video without crying every time!

What I call the neuro-diversity butterfly is already focused on a lot of the bad stuff and shows some of the overlaps, but there are some additional facts that make for sobering reading.

People with ASD are more likely to also be diagnosed with the following conditions (not exhaustive):
Anxiety
Bipolar disorder
Epilepsy
Sleep disorders
Gender dysphoria

People with ADHD are more likely to also be diagnosed with the following conditions (also not exhaustive):
Anxiety
Depression
Self-harm
Epilepsy
Bipolar disorder
Sleep disorders

Additionally people with ADHD are more likely to have addictions (gambling, alcohol, drugs, sex and gaming), higher rates of divorce, suicide and relationship failure and a higher chance of ending up in prison. People with ASD are much less likely to be married, have higher rates of suicide and be prone to addictions too.

People with ADHD tend to blurt things out and interrupt and people with ASD can sometimes speak inappropriately and have additional difficulties communicating. People with either condition spend a lot of time in their own head.

There are a lot of people who get diagnosed for mental health conditions where the root cause is actually one of the forms of neurodiversity (especially ASD and ADHD) meaning that their treatment/management plans may not be optimal.

The Good Stuff

Fig 3 – It’s already in ANS purple I didn’t even have to re-draw it…

You can redraw the neurodiversity butterfly showing some of the potential advantages, and in fact some of the most successful people are neurodiverse (or are considered to be by experts). They span a broad range of fields, just a few examples:

Us ADHDers tend to have a great sense of humour (we need it to survive) – it’s no accident that many comedians are known to have ADHD. People with ASD tend to score higher on intelligence tests, are extremely loyal, honest and are diligent hard workers.

The Practical

The reality is the medical view of Neurodiversity is evolving, it used to be thought that someone couldn’t have ASD and ADHD, but this position is changing. When I was at school, awareness of dyslexia was there but ADD (as ADHD was then known) was very patchy. That combined with me being bright enough to coast my exams meant that I was never diagnosed as a child, which is common for people of my age.

Neurodiversity isn’t something that just exists in our thoughts, there are actual structural and chemical differences in the way my brain operates to a neurotypical. There is strong evidence for a hereditary component to both conditions (my immediate family alone covers a large spread of Neurodiverse and corelated conditions).

This means that some of the downsides that come with Neurodiversity do actually benefit from formal treatment, both psychological and pharmaceutical. Common treatments for ASD and ADHD include Cognitive Behavioural Therapy (CBT) and medication, in the case of medications they are treating abnormalities with chemicals in the brain (dopamine and serotonin abnormalities are associated with both ADHD and ASD).

CBT will include a lot of practical advice about dealing with our limitations but often the Neurodiverse (especially us undiagnosed) have developed coping strategies (ask some of my colleagues about the times I’ve organised search parties to find where I’ve parked my car!)

There is no cure and medication doesn’t always make people’s conditions better, many make a choice to manage without medication because it can dull some of the characteristics that can be an advantage.

Neurodiversity at ANS

It is clear to me that at ANS we have more than our fair share of Neurodiverse (NDs) as well as plenty of Neurotypicals (NTs) and we are a better company for it.

Neurodiversity hasn’t prevented them being successful and in my own case at ANS, I think I’d be much less successful than I am now without being Neurodiverse.

The thing that keeps me at ANS (I’m counting the months to my 10 year watch right now) is this variety – I love different things (it’s a common trait for ADHD!). There are common themes in ‘ADHD friendly’ careers and both IT and sales are right up there. It is also unsurprising to me that computer programming and software is in the top five careers for ASD individuals. It’s no co-incidence that IT companies are leading the charge with explicit programs targeting Neurodiversity.

Fig 9 – No-one messes with the Neeson

You can’t tell someone is Neurodiverse by looking at them and many of us have become adept at hiding some of our obvious traits. To use myself as an example, I am front and centre with customers, so I need people to be able to be comfortable around me to do my job. This is called masking, it takes conscious effort so can be very draining.

I could write a book on it, but if anyone wants to know more just ask me (I recommend taking a look at some of the references I’ve linked too). The important thing is not to feel isolated if you feel different from some of your peers.

Am I Neurodiverse?

If you want an answer to that it is best to seek specialist advice, my first step was to reach out to an ADHD group before going via my GP (I had to teach her about ADHD in adults!). There are also several good self-assessment questionnaires which are not conclusive, but can be good to start a conversation with your GP if you wish to get diagnosed (fair warning it can be a long road!)

For me being Neurodiverse isn’t a problem I want to cure, but when my formal diagnosis comes it will help me not to feel like an outsider and is a club that I think I can truly belong to.

I think of the Neurodiverse as my tribe which I’m proud to be a member of, and I’m pretty certain that there are some other tribe members in ANS too.

Usually I’m full of praise for ambulance crews – going into the unknown where violent drunks make their lives hell, not to mention the cutbacks.

And I’m not going to be over critical of them. Or the police. The individuals do good work.

But all ‘establishment’ organisations work to procedures. That means that they have square holes – are you a square peg?

I am not.

I’ll describe what happened to me today.

Someone called me an ambulance – I can understand why.

I disagreed with them, told them to go away. They refused because…procedure. Because I had refused to allow them into the house to examine me they called the police. Procedure.

The police office was smart – they smiled a lot, agreed with me a lot and accepted that I didn’t want them in the house (I’ve been invaded by the police before – very bad experience). I explained what was going on and they were sympathetic, and then went away. Well done officer, good judgement.

Then the ambulance staff went back to their procedures.

I was offered all manner of assistance. No thank you. I was actually polite – but after the questions had gone on way too long I started to show my irritation. And the drip technique was terrible; reminiscent of Mrs Doyle offering a cup of tea. Go on. Go on. Go on go go on go on go on go on. Their procedures had not been satisfied so they set up camp outside my door.

At the four hour mark I’d had enough.

I called their control room and shouted at them.

Why would I do that? They’re just doing their job.

Because their job is not to make me paranoid.

It’s not to make a statement to the neighbourhood that I have a mental health issue by asking all my neighbours how I was.

It’s not to blow my carefully cultivated cover of living a quiet life and keeping my head down.

Hello stigma.

Thanks a lot.

So I called their control with an INSTRUCTION that they were to leave, and gave them ten minutes.

They snuck round the corner where they thought I couldn’t see them.

Since I could I went out to ‘talk’ to them. Not with them.

I’m not happy about that – they shouldn’t have people shouting at them for doing their job.

The problem is that their job is designed badly – if they meet a round peg they have to make it fit into the square hole.

I’m not picking on the ambulance service in particular – I’ve had the police, JC+, ATOS and many other agencies force me down inappropriate paths because…reasons (procedures).

It always ends up with me being in a worse position than I started in.

Let me repeat that in a slightly different way. If the agency had not taken action my condition would be better. Not only is that an epic fail, it’s also a monumentally costly fail that increases everyone’s stress load.

You can explain it to them: I have asked my doctor’s receptionist to not let me fall through a gap in the system – to let me fall through the gap less than a minute later because they couldn’t/wouldn’t take independent action.

I voz only following orderz!

postscript 10/10/18

It’s a phenomenal day. Sunny, 22C, light breeze – lovely.

I’ve just walked my dogs around the local reservoir. There was lapping water, ten cormorants in a row, a whole fleet of swans, a raft of one of the smaller species of gull (nice variety) and a heron.

I love this sort of stuff, it makes me feel OK with the world.

But today I just counted them and walked on, hyperventilating.

At lunchtime I got my meds out, a reminder that I’m due a refill. Overdue.

So it’s straight onto Patient Access to order them up.

Patient Access has been redesigned, so was unfamiliar. I clicked on repeat medication many times, because repeating the same action and getting the same result is science, but I’m a human being.

It turns out that my repeat medication has been suspended until I go in.

That’ll be a GP examination.

That’ll be an involuntary examination.

No.

The expression ‘cutting off your nose to spite your face’ was probably invented after someone met me. I have a display case filled with my previous noses.

I would rather live in squalor and misery for the rest of my life, unmedicated, than submit to an involuntary examination.

What’s happening?

Well, it’s procedure, innit!

I’m not due a review for another ten months but since the last one my life has been a succession of crises brought on by incompetent organisations that are allegedly there for my benefit, but who haven’t got a clue and mismanage, or make admin errors, that have profound effects on my life.

All the individuals mean well but all that seems to happen is box ticking and flow charts – what do we do with the round peg when we only have square holes?

There is a literal analogy – the peg either falls through or gets stuck and hammering only causes damage.

I’ve stopped hyperventilating now – I just feel cold inside. Hopeless. The inevitable consequence of relying on bureaucracies.

I’ll run out of meds tomorrow – I used to self medicate with booze. No prescription required.

The below is a commentary on the information given on GOV.UK, the official website of the UK government.
Quotations from the website are given in italics.

I’m a diagnosed ADHDer that loves driving. In the 1990s I became an Approved Driving Instructor. Although retired from that I have an interest in road law and have become an advocate against what I see as abuses of the legal system by both central and local government.

I’m worried by comments that I’ve heard from recently diagnosed ADHDers about advice given them by medical professionals on the subject of driving.

I sit in on a number of medical appointments and have witnessed for myself the confused message that can be given, especially considering that the client is often punch drunk from the experience.

There are several common misconceptions and some professionals are woefully out of date – I revisit this subject every year or so and the wording on GOV.UK can change, which it has since I last checked a few months ago.

The advice given by professionals is important – it would be negligent not to discuss driving but any information needs to be spot on – once the cat of disclosing ADHD is out of the bag, at the DVLA, it isn’t going back in again and they can ruin someone’s life with a simple mistake in admin.

The newly diagnosed could do without the hassle of a fight with faceless bureaucrats to keep/get back their driving privileges.

ADHD is clearly a potential notifiable condition so whether or not to disclose to the DVLA should be considered.
Telling someone that they should automatically disclose is foolhardy, for the reasons given above, unless there is a real concern that they are unsafe. If someone is unsafe then they should be told in very clear terms why that is the case and what is required of them.

The most recent changes to the text has made the position clearer, what they are looking for is someone that has ‘got worse since you got your licence‘.
Passing the UK driving test is difficult and it’s the official government approval of someone’s driving at that particular time.

Is a professional medic in the position to challenge this? If someone is clearly distractable or impulsive then they might not have the self awareness to know it – it’s clearly the medic’s job to tell them.

It’s worth discussing to find out where someone stands.

As a driver I make judgements all the time about my actions – should I do this, what could happen next and am I in a fit state to continue?

Yesterday I had a pint of shandy with my lunch and I drove afterwards. Later on I had another alcoholic drink (birthday) but I’d stopped driving for the day, we all have to consider at what point we transition from being a safe to an unsafe driver due to the variation in conditions (booze/weather/fatigue/familiarity with a vehicle or road etc).

I know of many people whose driving is ‘dodgy’. I don’t mean unsafe, I mean unsmooth or self restricted eg I know someone who won’t drive round a certain difficult roundabout – they’d prefer to walk home.

It’s a good decision, like my refusing to drive drunk. If something is beyond your safe capacity then don’t do it!

My point – anyone could be a legal driver and have driven to an assessment. Has the assessment changed their driving? If their pass was borderline and their condition is troubling then tell them to disclose.

What happens after a disclosure? The DVLA will write to the client’s doctor for opinion. It’s the opinion they should have given in the assessment, not kept a secret for later. That would be negligent of them since driving is a standard adult accomplishment.

I consider the blanket advice to disclose as a cop out and inconsiderate. Discuss driving and decide whether or not it’s an issue and go from there. If the client has a driving licence then questioning its validity, with that blanket disclosure advice, is tantamount to slandering the driving examiner that passed them. The caveat being that their driving capacity has decreased since the pass.

You must surrender your licence to DVLA if your doctor tells you that you need to stop driving for 3 months or more because of your medical condition.

You’ll usually get a decision within 6 weeks. You’ll get a letter from DVLA if it’s going to take longer.

DVLA might:

contact your doctor or consultantarrange for you to be examinedask you to take a driving assessment, or an eyesight or driving test

You can usually keep driving while DVLA are considering your application.

Is someone needs to disclose to the DVLA then they’ll need to disclose to their insurance company too. What will they do? They might withdraw cover. The premium should not change because they don’t have enough information to calculate their risk. Not yet.

When I started driving my sight was perfect, but now I need glasses. That’s a medical condition (visual impairment) which is listed but I don’t disclose…because it doesn’t affect my driving.

My eyes are definitely worse but I’m still within legal norms for eyesight, due to medical treatment (prescription – get glasses). Just because you have a condition it doesn’t necessarily follow that you need to disclose it, but you might.

I had ADHD when I passed the driving test when I was seventeen. I was a spotty, hormonal, mess with no driving experience. Many years later and I’m better in every way, apart from the eyes, and I’m also a treated ADHDer. Under the current rules I wouldn’t dream of disclosing, there is no upside but plenty of potential downside. If you are a legal driver, and are at least as good as when you passed, then you probably shouldn’t either.

If you are learning to drive then it’s worth talking to a decent professional that understands that there’s more to having a condition than the blanket approach.

I need to post something, now and again, to remind people that this page is still ‘live’.

It’s hard – the interweb is awash with ADHD stuff and I have little faith in my opinion, so don’t publish trivia from either.

It’s not as if I don’t have opinions ( I have opinions about everything, including things I haven’t heard about yet) but I have a modicum of self awareness, so don’t want to bore you with my meanderings. Errrrrrrrrrrrr.